In Reply: In response to Dr Swiontkowski, we
do not have any data about the rates of negative radiographs in children with
a history of forearm trauma over this time period, which would be the most
direct way to address this possible explanation. We doubt, however, that our
findings were influenced by changes in either access to care or thresholds
for ordering radiographs. First, we have previously reported that we found
no change in rates of distal forearm fractures in this sample between 1969-1971
and 1989-1991.1 Second, if there were an
increased likelihood of diagnosis in the later time periods, one might have
expected to also see an increase in incidence of fractures due to moderate
trauma over the same time period. This was not the case, as the increase was
largely limited to injuries related to more severe trauma.